This invention relates to treatment of periodontal disease, and in particular to a dental tray and method for delivering medicament subgingivally to treat the infected area.
Periodontal (gum) disease affects a majority of adults at some time in their lives. Warning signs often are unnoticed until advanced stages of the disease. Treatment methods depend upon the type of disease and how far the condition has progressed. When deep pockets (3 mm or greater) exist between teeth and gums, it is difficult for the dentist to thoroughly remove plaque and tartar. While surgery may be necessary to reduce the depth of the pockets or to restore or reshape bone that has been destroyed, typically it is preferable to attempt to avoid such invasive procedures by treating the affected areas with antibacterial or antimicrobal agents (i.e., chemical, antibiotic, or other pharmacological agents) to restore periodontal health. Such antibacterial or antimicrobal agents have been found to control the growth of bacteria that create toxins and cause periodontal disease and encourage normal healing, thereby reducing the necessity or the invasiveness of periodontal or oral surgery.
Several methods have been developed for treating periodontal disease that enable medicament to be delivered to the infected site below the gingiva. For example, U.S. Pat. No. 5,085,585 to Zimble discloses an applicator of dental medicament and method of use. FIGS. 3, 4 and 5 of Zimble show the applicator of that invention being inserted over the teeth. Column 2, lines 14–21, explain that in Zimble a corner 24 of a shoulder or collar 22 reaches the gum pocket 32 and “causes the gum to be forced outwardly.” In order to force the gum outwardly, the corner 24 of Zimble must enter the gum pocket to force the gum outwardly. Additionally, Zimble, at column 2, lines 24–27, reiterates that the collar enters the gum pocket. Zimble further discloses that the groove of approximately 2 mm by 2 mm is scribed into the periphery of the teeth of plaster model for forming the applicator 10. The groove is used to form the shoulder 22 (see col. 1, lines 63–65) which extends under the gum. It is therefore understood that the groove is formed within the tooth portion (not the gum portion) of the plaster mold so that the collar will be formed that will extend under the gum into the gum pocket.
Additionally, as set forth in U.S. Pat. No. 5,330,357, issued Jul. 19, 1994 to the present inventor, the disclosure of which hereby is incorporated by reference, medicament can be delivered in close proximity to the bone and supporting structure of the teeth by flossing using tufted floss, brushing using an interdental brush, injection using a syringe, or by hydrostatic or mastication pressure using a dental tray. Dental trays often are constructed from a soft plastic elastomeric material that is molded in place to a patient's teeth so as to firmly and closely fit in place on the patient's teeth, and a seal is made to hold the tray solidly against the dental tissues. Medicament is placed in recesses formed in the tray that are adapted to accommodate the patient's teeth, and then guided or forced along the teeth and into the gingiva by the sealing means to the infected site as the patient closes his jaw on the tray. A propulsion agent such as hydrogen peroxide also can be placed in the recesses to guide or force the medicament into the infected site as the hydrogen peroxide breaks down and increases the pressure within the recesses.
Other examples of dental trays are set forth in U.S. Pat. No. 4,902,227, issued Feb. 20, 1990 to Smith; U.S. Pat. No. 4,428,373 issued Jan. 31, 1984 to Seid et al.; and U.S. Pat. No. 4,138,814, issued Feb. 13, 1979 to Weitzman. While these types of dental trays do allow for application of the medicament subgingivally, none of these references discloses a dental tray that applies positive pressure to the tooth or edentulous region associated with the infected area to assist in forcing the medicament into the infected site.
U.S. Pat. No. 3,874,084, issued Apr. 1, 1975 to Cole, discloses a molded tooth cleansing and gingival therapeutic device that includes a plurality of bristles projecting inwardly from the inner walls of the upper and lower channels of a tray. The bristles are provided to clean food particles and bacteria from the surfaces of a user's teeth and the gingival crevices. The walls of the channels are of a sufficient thickness to form ridges or ledges extending away from the gingival lines. These ridges compress the gingiva to allow for cleansing of the gingival crevice between the teeth and gum and massaging of the free marginal gingival. However, the Cole device does not form a sufficient seal around the teeth and gums to allow for application of medicaments subgingivally and the penetration of the bristles would negate any positive pressure environment.
Thus, it is desirable to provide a dental tray and method for treatment of periodontal disease that provides a seal around teeth associated with the infected area to guide or force medication onto the surface of the teeth and subgingivally into the infected area. Such a seal can be modified to correspond to the nature of the diseased state, and also should assist in holding the medication in a desired location corresponding to the infected site. Such a tray and method of treatment also should be easily and conveniently administered by the patient, without special training or undue skill.